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New treatment methods suggested by “AlishechVMC” to our patients.
Parkinson’s Disease is a medical condition that was reported in 1817 by a doctor from London – James Parkinson. 60 years afterwards this disease was named after the doctor as Parkinson’s disease. Nowadays Parkinson’s disease is the second most spread degenerative brain disorder (the first one is Alzheimer’s disease). This condition is mostly common among older people and 1% of people in developed countries who are older than 65 years are diagnosed with Parkinson’s disease. Parkinson’s disease is the one and only degenerative brain disorder that has an effective expectant treatment.
Parkinson’s Disease treatment concentrates on the 5 main aspects:
Even the autopsies that were performed on Parkinson’s disease patients in the last century have shown dramatic dopamine drop in basal ganglia and that was a reason why these patients were given Levodopa – dopamine precursor. This treatment method had a positive clinical effect. The researches were in progress and in 1967 an article summarizing all the previous Parkinson’s patients’ Levodopa therapy results was published in “England Journal of Medicine”. From the time of first Levodopa use in clinical practice for brain neurotransmitter change it is considered to be a revolutionary breakthrough in Parkinson’s disease treatment.
Some researches on Levodopa efficiency improvement and its quantity intake increase by means of breakage inhibition in periphery with help of Dopa Decarboxylase Inhibitor enzyme were published in late 60-s. Levodopa and Dopa Decarboxylase Inhibitor enzyme combination had an increased efficacy on Parkinson’s disease patients’ motor symptoms and helped to cut the Levodopa dosage what reduced its side effects. In early 70-s treatment with combination of Levodopa and Dopa Decarboxylase Inhibitor enzyme was considered as a standard in the world for Parkinson’s patients therapy. Up to date there are some Levodopa products that are used in Israel in combination with other different types of Dopa Decarboxylase Inhibitors: «Levopar Plus», «Dopicar».
Despite the efficacy, reliability and availability of Levodopa all around the world, it has no satisfying effect on patients in long-term perspective and that is connected with the fact that the disease progression and chronic Levodopa ingestion cause the late side effects such as motor changes from the satisfying motor state (On) to critical motor state (Off). In this context appear involuntary movements – dyskinesia. In fact, it was discovered that additionally to motor damage there are numerous accessory non-motor symptoms that are connected with neurotransmitters activity, for instance, serotonin, noradrenaline and glutamate. Every disease state performs its own motor disorders that stay unchanged even after Levodopa intake, for example, postural and gait disorder, walking stagnation, falls, etc., as well as non-motor disorders: cognitive dysfunction, depression, autonomic disorders and sensor system disorders – that significantly decrease quality of patients’ lives. Nowadays, when it comes to treatment order the life quality always is taken into consideration because the main purpose of Parkinson’s disease treatment is not only a war against typical motor disorders, but also an influence on full range of disorders that appears in the disease’s progress and improvement of life quality. The most effective option is a deceleration of disease progression.
Dopamine agonist treatment methods: Treatment of major motor symptoms has several options. Direct dopamine receptor agonists have been the fundamental drugs for Parkinson’s disease treatment development for the last twenty years. However, dopamine agonists are less effective in improvement of clinical symptoms than Levodopa, they provide continuous and permanent dopamine-stimulation. Also they cause less motor fluctuations and dyskinesia. It is common to start the motor symptoms therapy with dopamine agonists and then continue the treatment with Levodopa drugs. The latest agonist innovation is a bringing of Rotigotine (dopamine agonist in a patch form that is absorbed through the skin) into clinical practice. This medicine accumulates the advantages of easy use and long-term exposure. Dopamine agonists’ side effects include a wide range of events: nausea, fatigue, vertigo, drowsiness and impulse control disorders. During the dopamine agonists treatment course those side effects call for special attention. That’s why some of the drugs of this type were disused. The most popular dopamine agonists in Israel are: Ropinirole Requip, Prolonged Modutab release formulation of ropinirole Pramipexole Sifrol. Additional drugs group that fortify dopamine - monoamine oxidase b inhibitors (MAO-B Monoamine oxidase B inhibitors) that consists of (Jumex) Selegiline and Rasagiline (Azilect) and affect on Off condition and motor symptoms in Parkinson's patients. Treatment of a progressive disease is not as effective as treatment at the onset moment. This stage also demands Levodopa drugs starting from low doses up to high ones as needed.
The crucial task for everyone who tries to manage the Parkinson’s disease is a creation of means for continuous excitation of the dopamine receptor and provision of a long and constant supply of Levodopa to the brain that is achieved by a constant level of Levodopa in the blood. The method that is used to achieve the goal is called as Continuous Dopaminergic Stimulation. For that reason, a whole new area – Interventional Neurology is being developed having a basement of invasive treatment means. Nowadays, there are only three methods of clinical application:
The first method
is a continuous levodopa (Duodopa) injections in the small guts through stoma at a constant rate through a special pump. This method has a great effect on motor fluctuations and reduces dyskinesia. The treatment requires leading a bougie and arranging of invasive procedure PEG/J, which is often connected with technical adverse events and is really expensive. This treatment method is common and available in European countries and in Israel.
To select the drugs correlating with this treatment, do not hesitate to contact our doctor on [email protected].
The second option
is a continuous subcutaneous injection of apomorphine dopamine agonist through a pump. Apomorphine is a specific dopamine agonist which has the same effect on Parkinson's disease's motor symptoms as Levodopa. It can be taken only parenterally and this is a huge disadvantage. Long-standing Apomorphine treatment requires a constant location of a needle under the skin what causes a lot of side effects on the intake site and some technical problems.
To select the drugs correlating with this treatment, do not hesitate to contact our doctor on [email protected].
The third method that is practiced today
is a stereotactic surgery by means of brain stimulation (Deep Brain Stimulation – DBS). Nowadays, the most spread procedure is Subthalamic Nucleus Stimulation. It is considered, that this treatment option is the second biggest breakthrough in treatment of Parkinson’s disease after discovery of the Levodopa. Also, Globus Pallidus Internal stimulation can be chosen according to patient’s clinical condition. DBS surgeries show improvement in the most part of motor symptoms in Parkinson’s disease, but they also have some adverse events either during the surgery or within the neuropsychological disorders and technical problems.
There are additional methods being developed and researched now, Levodopa in patch form – Transdermal Levodopa Patch, for instance, or special pill called Accordion Pill – AP, that controls ventricle release of Levodopa.
The recent progress in neurotransmitters system understanding (as far as it is involved into basal nuclei functioning) attracts all the attention to the non-dopaminergic ways and receptors (glutamate, adenosine, A2A), to different serotonin 5 receptors (5-hydroxytryptamine – HT), to alpha-adrenergic receptors and etc. Those receptors turn out to be the additional targets for development of new kinds of Parkinson’s Disease medicines. It must be added, that all the clinical researcher, that were taken previously and had a goal of dyskinesia and motor fluctuation reduction, have never proved the clear benefit of that type of drugs. Amantadine (PK MERZ) is an additional medicine with non-dopaminergic active mechanism. Amantadine is NMDA receptor antagonist (N-methyl-D-aspartate) and it has a positive influence on dyskinesia throughout the Parkinson’s Disease and has a smaller effect on other motor symptoms. Amantadine is an antiviral drug that was found to be effective in relief of Parkinson’s motor symptoms. Apart from motor problems, there are also some additional problems that plague patients’ lives out such as dementia, depression, apathy, anhedonia, mental affection, insomnia, pain, periuria, postural hypotension, constipation, drowsiness, etc. These events cause a huge damage to Parkinson’s patients’ quality of life. To solve these problems symptomatic treatment is needed to be adjusted in accordance with patient’s condition and potential adverse events. It is noteworthy that Rivastigmine is an optional treatment for the Alzheimer’s disease, for dementias in Parkinson’s disease and Clozepine is used for psychosis treatment in Parkinson’s patients and their efficiency was proven in controlled studies.
The aim of an any Parkinson’s disease therapy is a delay in breakdowns and prevention of complications. The ultimate treatment goals are a modification of pathologic process, deceleration of disease progress, prevention of motor and non-motor complications on a critical stage of the disease. In September, 2009 in one of the most affluent medical journals was published an article proving that an early treatment with Rasagiline (Azilect) in a dosage of 1 mg daily has a great positive effect on disease progression.
Now this medicine is prescribed to every patient in Israel with Parkinson’s disease in an initial stage as a first-line drug. It s considered that administration of 1 mg of Azilect at night blocks the development of the disease for several years. Trimestral treatment course cost is 750$ USD. You can order the medicine on this page. (Azilect 1 mg (Rasagiline) 30 tabl x 3 boxes)
Presently the treatment with intracranial injection of viral vectors that are therapeutic genes delivery agents and treatment with Growth factor delivery method aimed at enhancing of dopaminergic terminals residuals activity are being developed. Rehabilitation treatment opens a great future perspective on curation but now there are more questions than answers and it also brings up some questions concerning reliability and the effect on non-motor symptoms. Primary Neuroprotection turns out to be a question of great importance as far as it is essential to determine prevention or postponing of disease’s onset. At this stage there are no any clear keys for detecting the risk factors for the disease and that’s why it is impossible to take neuroprotective researches on people with a potential risk of disease development. The preclinical Parkinson’s disease stage takes about 6 years. And this time gap gives a good opportunity of undergoing the neuroprotеctive therapy. Researches aimed at finding any marks of preclinical Parkinson’s disease stage are constantly gaining an interest. Physical activity has a significant meaning for modification of disease’s behavior and it was also proven in many clinical investigations that intensive physical activity delays the onset of Parkinson’s disease in men.
It is proven that administration of 1 mg of Azilect at night blocks the development of the disease for several years. That’s why it is recommended as a first-line diagnostics medication.
Active ingredient – Rasagilin, 1 mg
90 pills (3 packs, trimestral treatment course) Cost – 360 $
Manufacturer: Teva Pharmaceutical, Israel
If the disease lasts for several years, it is recommended to take the second-line drugs – different combinations of Levodopa. Levodopa is dopamine precursor that transforms in the organism. Up to date, Levodopa in its different combinations is thought to be the most effective drug against Parkinson’s disease with all the accompanying symptoms. Levodopa is prescribed in dosage of 125 mg * 3 times daily. Depending on the need, the dosage can be increased. It is considered that the optimal dose is 750-1250 mg daily. If you were prescribed with Sinemet, you should know that its correct dosage is 200 mg * 2 times daily.
Duodopa drugs (Carbidopa 25 mg / Levodopa 200 mg)
While using these drugs try to avoid much proteins and vitamins B6 in your meals.
Consult your physician before use.
Treatment of Parkinson's disease Treatment of Parkinson's disease